Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FFP Medicine > Surgery and Med: GI and hepatobiliary > Flashcards

Surgery and Med: GI and hepatobiliary Flashcards

1
Q

What is the most likely causative organism of ascending cholangitis?

A

E. coli
(then Klebsiella and enterococcus) -pseudomonas and streptococcus are less common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is a marker of hepatocellular carcinoma?

A

raised alpha feto protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are pigmented gallstones associated with?

A

sickle cell anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is reynold’s pentad?

A

Charcot’s triad plus hypotension and confusion- it is a sign of severe ascending cholangitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is Murphy’s sign?

A

elicited in patients with acute cholecystitis by asking the patient to take in and hold a deep breath while palpating the right subcostal area. If pain occurs on inspiration, when the inflamed gallbladder comes into contact with the examiner’s hand, Murphy’s sign is positive.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

which is the single best investigation to order for suspected pancreatitis >24hours

A

serum lipase (longer half life)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Boerhaave’s syndrome?

A

spontaneous rupture of the oesophagus that occurs as a result of repeated episodes of vomiting. The rupture is usually distally sited and on the left side.

Patients usually give a history of sudden onset of severe chest pain that may complicate severe vomiting. Subcutaneous emphysema may be observed on the chest wall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what investigation is used for cholangiocarcinoma

A

CA 19-9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is one of the key management protocols in acute pancreatitis?

A

early and aggressive fluid resuscitation which is to correct the third space losses and increase tissue perfusion with the aim of preventing severe inflammatory response syndrome which can lead to pancreatic necrosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what are the LFT/ inflammatory markers like in biliary colic?

A

normal if no fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

which condition would have pain radiating to right shoulder/interscapular region

A

biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Rovsing’s sign?

A

compressing L lower quadrant elicits pain on R iliac fossa (appendicitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is rigler’s sign?

A

double bowel wall seen on x ray-> perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

RF of gallstones (11)

A

Obesity
Female sex
Diabetes
Family history
Chronic loss of bile salts (e.g., terminal ileal disease, Crohn’s disease)
Oral contraceptive pill
Pregnancy
Rapid weight change (e.g., bariatric surgery)
Chronic haemolysis (e.g., sickle cell anaemia, G6PD deficiency)
Increasing age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when would you use open non-mesh repairs in inguinal hernias?

A

irreducible or strangulated hernia, as mesh would lead to higher chances of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the clinical signs of a femoral hernia

A

irreducible, inferior to the inguinal ligament and inferior and lateral to the pubic tubercle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

when should clopidogrel and aspirin be stopped before surgery?

A

7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when should warfarin be stopped before surgery?

A

5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when should ACEi be stopped before surgery?

A

the day before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

when should sulphonylureas be stopped before surgery?

A

Sulfonylureas should be held on the day of surgery due to the risk of hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

when should oral contraceptive pill be stopped before surgery?

A

The pill should be stopped 4-6 weeks before surgery, and re-started at least 2 weeks after surgery (when the patient is mobile). This reduces the risk of DVT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when is unfractioned heparin indicated over LMWH?

A

renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how are LMWH monitored in patients?

A

Anti-factor Xa levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is oesophageal adenocarcinoma associated with?

A

GORD and barrett’s oesophagus (not ass with alcohol) located in lower 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what is squamous cell carcinoma of the oesophagus related to?

A

smoking and alcohol excess. proximal 2/3 of oesophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what medications are ass with peptic ulcer disease

A

NSAIDs, SSRIs, chronic use of steroids,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is pernicious anaemia?

A

relatively rare autoimmune disorder that causes diminishment in dietary vitamin B12 absorption, resulting in B12 deficiency and subsequent megaloblastic anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is Courvoisier sign?

A

painless palpable enlarged gallbladder (with jaundice)- cancer of head of pancreas

29
Q

What is the typical nature of dysphagia in oesophageal carcinoma?

A

progressive dysphagia from solids to liquids.

30
Q

histological signs of Crohn’s

A

submucosal fibrosis (UC only affects mucosa)

31
Q

how do you describe the internal opening of a fistula?

A

Goodsall’s rule: if external opening is anterior to transverse anal line the tract will run straight, if not it will run curved and anterior/ posterior to transverse line

32
Q

What is diverticular disease?

A

presence of diverticular (outpouchings of the mucosa and submucosa, typically affecting the sigmoid colon).

33
Q

physical examination signs of diverticulitis

A

pyrexia and left lower quadrant tenderness/guarding. Diffuse abdominal tenderness is suggestive of perforation or generalised peritonitis.

34
Q

treatment of diverticular disease? (conservative and medical)

A

conservative: fluid and fibre, smoking cessation and weight loss
medical: analgesia- paracetamol, bulk forming laxatives

35
Q

treatment of diverticulitis?

A

admission A-E
IV fluids, avoid solids 2-3 days, analgesia paracetamol, broad spectrum IV Abx (taz, co amox+/- mdzole), surgery if complications eg perforation- hartmann’s procedure

36
Q

What are the 6 main complications of diverticular disease?

A

Diverticulitis
Rectal Bleeding
Diverticular stricture
Fistulae
Perforation
Colonic Abscess

37
Q

what does facecal calprotectin measure?

A

inflammation (non specific), raised in diverticulitis, IBD, IBS

38
Q

What are the complications of diverticulitis?

A

Bowel perforation
Bowel obstruction
Vesicointestinal fistula
Rectovaginal fistula
Sepsis
Colonic stricture
PR bleeding

39
Q

What would you expect to find on abdominal X-ray in patients with gallstone ileus?

A
  1. air in the biliary tree (pneumobilia)
  2. small bowel obstruction 3. gallstone (most commonly in the right iliac fossa- calcified) would heavily indicate gallstone ileus. This triad is known as Rigler’s triad.
40
Q

What are the features of biliary colic?

A

Colicky right upper quadrant pain
Worse after eating
No fever
Murphy’s sign negative

41
Q

what may be seen on biopsied gastric adenocarcinoma?

A

signet ring cells. They contain a large vacuole of mucin which displaces the nucleus to one side. Higher numbers of signet ring cells are associated with a worse prognosis

42
Q

In Primary biliary cholangitis, what is the M rule

A

IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females

43
Q

what is Haemochromatosis?

A

autosomal recessive disorder of iron absorption and metabolism resulting in iron accumulation. It is caused by the inheritance of mutations in the HFE gene on both copies of chromosome 6.

44
Q

what is diagnostic of malnutrition in terms of weight?

A

Unintentional weight loss greater than 10% within the last 3-6 months is diagnostic of malnutrition

45
Q

what is the the single strongest risk factor for the development of Barrett’s oesophagus

A

GORD

46
Q

what type of LFT abnormality would be present in pancreatic cancer?

A

cholestasis- raised ALP and GGT

47
Q

what are the most common type of pancreatic cancer and where on the pancreas?

A

adenocarcinoma, head of pancreas

48
Q

what medication should be avoided in bowel obstruction?

A

Metoclopramide- has prokinetic properties- can stimulate peristalsis- perforation and exacerbate mechanical bowel obstruction

49
Q

what is the LFT derangement in alcoholic liver hepatitis?

A

AST:ALT >2
if its >3 can suggest acute alcoholic hepatitis

50
Q

what is the most common disease pattern in UC?

A

proctitis

51
Q

how do you manage a severe flare up of UC?

A

admit and IV corticosteroids

if after 72 h there has been no improvement, consider adding intravenous ciclosporin to intravenous corticosteroids or consider surgery

52
Q

what is used for severe alcoholic hepatitis?

A

prednisolone/ corticosteroids

53
Q

which blood tests are used to monitor haemachromatosis?

A

ferrin and transferrin saturation

54
Q

what is biopsy likely to show in oesophageal cancer if ass with GORD or Barrett’s and consistent with an obstructive lesion?

A

adenocarcinoma

55
Q

what is the most common site affected in UC?

A

rectum (inflammation always starts there)

56
Q

what is the most common site affected in Crohn’s?

A

ileum

57
Q

what should be added if If a mild-moderate flare of ulcerative colitis does not respond to topical or oral aminosalicylates

A

add oral corticosteroids

58
Q

what is the histology of coeliac diseaes?

A

villous atrophy, raised intra-epithelial lymphocytes, and crypt hyperplasia

59
Q

what is the histology of crohn’s?

A

inflammation in all layers from mucosa to serosa
goblet cells
granulomas

60
Q

what are the endoscopic findings of UC?

A

no inflammation beyond submucosa (unless fulminant disease)
widespread ulceration with preservation of adjacent mucosa which has the appearance of polyps (‘pseudopolyps’)
inflammatory cell infiltrate in lamina propria
neutrophils migrate through the walls of glands to form crypt abscesses
depletion of goblet cells and mucin from gland epithelium
granulomas are infrequent

61
Q

what is the MOA of loperamide

A

Loperamide is a μ-opioid receptor agonist which does not have systemic effects as it is not absorbed through the gut (reduction of gastric motility)

62
Q

MOA of azathioprine?

A

immunosuppressive agent that acts through its effects as an antagonist of purine metabolism, resulting in the inhibition of deoxyribonucleic acid (DNA), ribonucleic acid (RNA), and protein synthesis.

63
Q

what is the Ix of choice in someone with severe UC?

A

flexi sigmoidoscopy as colonscopy has risk of perforation

64
Q

what cancers are at increased risk with HNPCC?

A

colorectal, pancreatic, endometric

65
Q

what is first line to induce remission in crohn’s?

A

glucocorticoids

66
Q

what would metabolic ketoacidosis with low glucose suggest?

A

alcoholic ketoacidosis

67
Q

treatment for life threatening C diff infection (toxic megacolon)

A

IV metronidazole and ORAL vancomycin (delivery to gut)

68
Q

what is the triad for acute liver failure?

A

triad of encephalopathy, jaundice and coagulopathy

FFP Medicine (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions